5/2/2017

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Randi Roy, Chief Strategy Officer

Shaun Ruskin, VP, Business Development and Post Acute Services

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Bundles of Joy: VillageCare as a

Model 3 BPCI Episode Initiator -

Journey toward Full Risk

LeadingAgeNYAnnual MeetingMay 24, 2017

The Future of Value-based Care 2

5/2/2017

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VillageCare, with 40 years of service to New York, served approximately 25,000 individuals in 2016

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Post-Acute Nursing Facility

(1,600 patients

discharged home annually)

Health Home, Housing and other

community programs (13,000 +members)

ManagedCare Plans (8,000+ members)

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VillageCare offers three discrete service lines

Post‐Acute

Care

Community Supports

Managed care

Village Center for Rehab & Nursing

Rango – Technology for Treatment Adherence

Managed Long Term Care PlanVillageCare Health Home

5/2/2017

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Overview of Post-Acute Facility: VCRN5

New modern facility; built 2010

1,600+ admissions per year

Rehab offered 7 days per week

Full medical staff including onsite NPs 16hrs per day 

Advanced Care Unit, clustering highest acuity patients

Nursing to patient ratio is 1:13

Ability to admit 7 days per week

Only BPCI Model 3 post‐acute facility in NYC 

16.9%

24.7%

21.2%

18.8%

24.9%

17.0%

21.1%

23.7%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0%

VCRN

MARY MANNING WALSH

AMSTERDAM

THE RIVERSIDE

THE NEW JEWISH HOME

ISABELLA

GOUVERNEUR

UPPER EAST SIDE

Lowest Rehospitalization Rate of Peer Facilities – 30 days 

Source: Rehospitalization rate from CMS Nursing Home Compare

7.6% : 30‐day In‐house Rehospitalization Rate (Equip)

CMS 5 Star facility2010‐2017

History of decision to pursue BPCI 6

Hedging our bets 

• Healthcare shift toward Value Based Payment 

arrangements 

Learning how to Manage Risk 

“Skin in the game”, referral source appreciation  

Marketing benefits

Experience with NYU’s Model 2 bundle

• Pioneers in NYC, 2013

• Partnering to manage utilization and re‐

hospitalization protocols with Major Joint 

Replacement and Cardiac Valve

5/2/2017

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Implementation 7

Selecting our partner with CMS

• Remedy Partners, Awardee Convener

Choosing our bundles with Remedy Partners

• Historical Data

Hiring a Post Acute RN

• Managing patients throughout the entire episode, 

Day 1 through Day 90 

Monitoring

• Reporting mechanism to ensure success

Care Redesign: Transitional Care8

• Created a Transitional Care Program

• Hired an RN with population health training

• Created protocols and workflows 

• Upon admission

• During stay 

• Upon discharge

• Utilized an IT platform 

• Began post‐discharge calling program: Focused on 

5 keys areas 

• Assessing performance and refining processes 

• Congestive Heart Failure example

5/2/2017

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Post-Discharge Transitional Care 9

• PCP and Specialist appointments scheduled within 5‐7 days?• Questions:  Transportation? Someone to attend with you? 

• Medication management?• Questions:  Do you have the ability to purchase and obtain the medication?

• Caregiver support/ home care arrived? • Questions:  Is there a recognition of caregiver strain? 

• Has the DME arrived? • Questions:  Do you know how to use it?  

• CHF example

• Barriers to self‐care?• Questions:  Can the individual buy food, pay bills, take care of themselves? 

Partnership for Home Care10

VNSNY

• Partnering with a Certified Home Care Agency 

to deliver high quality of care 

• Continuity of care from hospital, to SNF, to 

Home

• Post Acute Pathways to reduce avoidable 

rehospitalizations; 

• Weekly and Monthly communication to 

discuss individual patient issues, lessons 

learned, and best practices

• Innovative ideas to deliver high quality of care 

at a lower cost; sharing of claims data

• Review of Key Performance Metric on 

quarterly basis

5/2/2017

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Marketing and Relationships11

Only Model 3 SNF in all of NYC that elected to participate 

in the BPCI initiative

• Upside – “Get out of jail free” card

• Downside – Referral sources wanting to manage their 

own bundles

Demonstrates that we have “skin in the game”, and can 

be penalized ‐ just like our hospital partners

Marketing differs contingent on the hospital’s bundle 

voluntary or mandatory participation 

• Model 2 hospitals

• Comprehensive Care for Joint Replacement (CJR)

Program Performance – Major Joint12

$18,000

$18,500

$19,000

$19,500

$20,000

$20,500

$21,000

$21,500

$22,000

Average Episode Cost

Epis

ode

Cos

t

MLJ Bundle Performance

First 3 Qs Last 4 Qs

Reductions in LOS (3 days) and readmissions (12 to 10) from first three quarters to last four quarters – 195 total episodes

5/2/2017

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Congestive Heart Failure (CHF)13

Skilled Nursing Facility68%

Home Health9%

Outpatient2%

Post-Anchor Inpatient

10%

Post-Anchor Part B11%

CHF

Congestive Heart Failure• Important to referral

partners• Opportunity for

patient education and palliative care

• Implemented Care Redesign during SNF stay

• Targeting for Admission diversion

Program Performance - CHF14

$20,544

$37,508

$-

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

$40,000

Average Episode Cost

Congestive Heart failure

w/o Readmit with Readmit

5/2/2017

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Overall Program Performance vs. all Remedy Model 3 programs

15*NPRA as % Program Size (Net of CMS 3%)

Other APMs16

• Targeting 80% of revenue in VBP 

by 2020

• Case rates with United and 

Emblem

• Allows for pre‐authorization 

to take patients directly

• Another contract pending

• Looking at ACOs

• Participating in risk arrangements 

with hospital partners

5/2/2017

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Ongoing Management17

Working with Remedy Partners 

• Receiving, analyzing, and understanding our data

• Dropping bundles that are not viable

Using data for Marketing Efforts

• Marketing for specific diagnosis

• Driving volume to successful bundles

Monitoring and Reporting

• Reporting Mechanism to ensure this program 

makes sense, and aligns with organization’s strategy

Plans for the Future18

Population health initiative

• Organization‐wide effort to share best practices 

across service lines

• Continue to quantify our value as partner

Disease specific team and pathways – Improve patient 

quality of life; reduce readmissions

• Implemented nurse‐led team, family champion 

contract, joint education materials with hospital 

and home care agency

Full Post‐Acute risk with home care partner VNS

VBP across the organization 

Advanced BPCI ‐ 2018

5/2/2017

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©2014 The Advisory Board Company • advisory.com 29490B

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Visibility Requires Quality Impact on a Large Scale

Healthcare Cost and Utilization Project, “Statistical Brief #172: Conditions with the Largest Number of Adult Hospital Readmissions by Payer,” Agency for Healthcare Research and Quality, 2014, http://www.hcup-us.ahrq.gov/reports/statbriefs/sb172-Conditions-Readmissions-Payer.pdf; Florida Office of Program Policy Analysis and Government Accountability, “Profile of Florida’s Medicaid Home and Community-Based Services Waivers,” 2012, http://elderaffairs.state.fl.us/doea/Evaluation/Profile%20of%20Florida's%20Medicaid%20Home%20and%20Community-Based%20Services%20Waiver%20OPPAGA%2012-03.pdf; Vaidya A, “8 Statistics on the Average Cost Per ED Visit,” Becker’s Hospital CFO, May 31, 2013, http://www.beckershospitalreview.com/finance/8-statistics-on-the-average-cost-per-ed-visit.html; Post-Acute Care Collaborative interviews and analysis.

1) Per month.

How Can We Reach $1 Million Impact?

Cost Savings Opportunity

Single Occurrence Cost Assumption

Needed to Reach $1 Million

Hospital Readmissions

$13,333 75

One-Day Reduction in SNF Length of Stay

$480 2,083

Readmissions avoided

ED Diversion $1,062 942 ED visits prevented

Days eliminated

One last thought…..20